PURPOSE OF THE STUDY.
To prospectively describe the changes in eczema prevalence and the influence of gender and atopy from birth to 18 years of age within a single cohort of children.
All children enrolled in the 1989 Isle of Wight, United Kingdom, birth cohort (N = 1536) were recruited, and 1456 children consented to participate in the study. Ninety-nine percent of the population was white and lived in a semirural region with no heavy industry.
Subjects were assessed for eczema at 1, 2, 4, 10, and 18 years of age with a detailed questionnaire and physical examination. Atopy was evaluated through skin testing to select indoor and outdoor aeroallergens and to foods commonly implicated in allergy. Only 1- and 2-year-old subjects who were symptomatic with their eczema were skin-tested, whereas all 4-, 10-, and 18-year-old subjects were skin-tested. χ2 tests were performed to estimate the difference in eczema occurrence and resolution rates during the observation periods.
Eczema data were obtained from >80% of the subjects at all times points. No differences in the prevalence of eczema were found in boys compared with girls between 1 and 10 years of age. However, at 18 years of age, the prevalence of eczema was significantly higher in girls compared with boys (P < .001). This shift after puberty was driven both by an increase in the development of nonatopic eczema in girls (P = .012) and by an increase in the resolution of atopic eczema in boys (P = .044). Focusing on a subset of 160 subjects with onset of eczema at ages 1 or 2 years, 16.9% had persistent eczema at 18 years of age. Recurrence was documented in 17.5% of those who had remission at 4 years of age and 10.9% of those who had remission at 10 years of age. Finally, 41.9% of this subset had complete resolution through 18 years of age.
Although the prevalence of eczema seems to be independent of gender and atopic status in childhood, the prevalence of eczema in girls after puberty becomes greater than that of boys as a result of an increase in nonatopic eczema in girls and a decrease in atopic eczema in boys. Overall, the prevalence of eczema decreased with age; only 16.9% had persistent eczema at 18 years of age.
Because of the homogeneity of the study population, one should be cautious in extrapolating the data to mixed populations such as in the United States. However, the large cohort size and long observation period are key strengths of this longitudinal study, the results of which provide insight into the natural history of this chronically relapsing and remitting disease.
- Copyright © 2011 by the American Academy of Pediatrics